title: Adverse effects of preoperative steroid use on surgical outcomes.
abstract: BACKGROUND
  Preoperative steroid use has been associated with increased postoperative complications. We sought to establish these risks using data from the National Surgical Quality Improvement Program (NSQIP).
  
  
  METHODS
  NSQIP public use files from 2005 to 2008 were analyzed for preoperative steroid use and postoperative adverse events.
  
  
  RESULTS
  Of 635,265 patients identified, 20,434 (3.2%) used steroids preoperatively. Superficial surgical site infections (SSI) increased from 2.9% to 5% using steroids (odds ratio, 1.724). Deep SSIs increased from .8% to 1.8% (odds ratio, 2.353). Organ/space SSIs and dehiscence increased 2 to 3-fold with steroid use (odds ratios, 2.469 and 3.338, respectively). Mortality increased almost 4-fold (1.6% to 6.0%; odds ratio, 3.920). All results were significant (P < .001).
  
  
  CONCLUSIONS
  Previous concerns related to surgical risks in patients on chronic steroid regimens appear valid. These results may assist in counselling patients regarding the increased risk of surgery. They may also help the surgeon plan and modify the procedure if possible.
authors.affiliation: Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: Hishaam
authors.initials: H
authors.lastname: Ismael
authors.forename: Mathilda
authors.initials: M
authors.lastname: Horst
authors.forename: Maria
authors.initials: M
authors.lastname: Farooq
authors.forename: Jack
authors.initials: J
authors.lastname: Jordon
authors.forename: Joe H
authors.initials: JH
authors.lastname: Patton
authors.forename: Ilan S
authors.initials: IS
authors.lastname: Rubinfeld
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality; D057234:Preoperative Period; D058996:Quality Improvement; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality / Q000592:standards*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones